African American Doctors on Building Trust for the COVID-19 Vaccine
The COVID-19 pandemic has been especially devastating for the African American community. African Americans are almost three times more likely than whites to be hospitalized as a result of COVID-19 and almost two times more likely to die from the disease, according to Centers for the Disease Control and Prevention (CDC).
The reasons are many and interrelated: socioeconomic status, pre-existing medical conditions such as diabetes, access to health care, and exposure to the virus as essential workers. At the same time, as the COVID-19 vaccine is rolling out, African Americans are vastly underrepresented among those getting vaccinated. According to the CDC, 60.4% of those vaccinated have been white and only 5.4% African American, even though African Americans are estimated to account for around 13% of the population.
One of the reasons for this disparity is vaccine hesitancy. A Texas A&M University-led study found that among those intending to reject the vaccine, African Americans respondents were more likely than whites to cite concerns about the vaccine’s safety and effectiveness, and their lack of insurance and financial resources.
We wanted to learn how doctors are addressing their African American patients’ concerns about the COVID-19 vaccine and its distribution. Charles Williams, the Director of Business Development at Sensis and a member of the SensisHealth team, talked to two African American doctors in Kentucky to find out: Dr. Kamara Garner, a primary care physician specializing in family medicine at University of Louisville Health and Dr. Jai H. Gilliam, an internal medicine and pediatrics physician at Baptist Health in Nicholasville. Here are our takeaways from their conversation:
1. COVID-19 vaccine skepticism is rooted in systematic discrimination. “Medicine is a big chapter of darkness in the African American community. We’re hesitant to take the COVID-19 vaccine because every time we’ve been told ‘trust us,’ we were never the patient. We were always the subject,” Dr. Gilliam said.
Both doctors cited patients bringing up the Tuskegee syphilis study, the twentieth-century experiment in which the U.S. government exploited 600 African American men in a syphilis study by lying about the study’s purpose and deliberately withholding adequate treatment. The study lasted from 1932 to 1972.
The Tuskegee experiment underlines how the COVID-19 vaccine hesitancy in the African American community is the culmination of centuries of racial discrimination. “One of the things that this pandemic has done is highlighted the broken-down infrastructure of our healthcare system, namely, systemic racism. You can go back all the way to slavery. You can go all the way back to post-Civil War. You’re [African Americans] free, but even though you’re free, you don’t get the optimum healthcare. Even though you’re free, you’re not put in the wealthiest parts of town. There is redlining and all the other different things that go into systemic racism that puts us at a disadvantage when it comes to getting healthcare, jobs, loans — all these different things play on our health,” said Dr. Gilliam.
African Americans, including those of the younger generations, are keenly aware of this historical mistreatment by the medical establishment. “My younger patients are the ones who’ve been more hesitant about the COVID-19 vaccine. On more than one occasion, they have brought up the Tuskegee experiment. We’ve had to talk about that, what happened there, and how the COVID-19 vaccine is not that,” said Dr. Garner.
2. To build trust for the COVID-19 vaccine, the medical community must show it’s safe for African Americans to get vaccinated. Vaccine hesitancy among African Americans is a legitimate concern and must be addressed as such. Sharing trustworthy information is critical to countering misinformation about the vaccine. “One of my responses has been to simplify, as much as possible, how the vaccine works. I’ve talked to my patients about how this is the first time in many years where we’ve actually needed a new vaccine,” said Dr. Garner.
In informing patients about the COVID-19 vaccine trials, it is important to illustrate that the vaccine has been highly effective and safe for the African American participants in these trials. “At the end of the day, regardless of your race, ethnicity, body, mass index, age, gender, everybody has the same end point of that 94% effectiveness [for the COVID-19 vaccine] and getting the antibody response. When you put that out, there is no wool over the patients’ eyes,” said Dr. Gilliam.
3. Make vaccination outreach truly equitable. This will require a strong communications effort by the U.S. government. Dr. Gilliam wants to see strong push from the CDC and the National Institutes of Health (NIH) that includes public service announcements promoting the COVID-19 vaccine to the African American community. Dr. Garner believes that having trusted community leaders such as pastors of African American churches publicly discuss their vaccination experiences would help allay worries of those still hesitant.
Even when African Americans are willing to get vaccinated, accessing the COVID-19 vaccine can be much more difficult than for white Americans. During a health crisis in which health institutions are relying on the internet in ways like never before, patients without access can get left behind. According to a 2019 Pew Research Center study, although African Americans owned smartphones at a rate similar to whites (82% and 80%, respectively), there was a much wider gap in home broadband. While 79% of whites had home broadband, only 66% of African Americans did.
Dr. Garner noted that some of her patients only have a landline or a flip phone with no internet access. When one of her patients attempted to sign up for the COVID-19 vaccine by phone, the patient was told to sign up online. “With this vaccine, everything is ‘sign up online.’ Well, what if you can’t do that? Those things have to be taken into account,” said Dr. Garner. The medical community must work to expand access to telemedicine, counter misinformation about vaccinations, and more to better serve African Americans not only during the pandemic but after this health crisis is over.
